Parents are usually concerned when they notice that their child’s feet are flat. Often, they take them to the doctor only to be told that their child will outgrow the deformity, which is often the case; however, in the instances when they don’t, they become more susceptible later in life to heel pain, arthritis and tendonitis. Treated early and aggressively, these conditions can be avoided in most cases.
Flat feet are also referred to as pes planus, pes planovalgus or pronation syndrome. It is commonly described as a foot without an arch. There are two types of flat foot: flexible and rigid. In a rigid flat foot, the arch appears flat when the child is sitting and standing. In a flexible flatfoot, the arch appears normal while the child is sitting but it collapses when the child bears any weight on the foot. The flexible form is less severe, more common and easier to treat. Flat foot is a normal part of the developmental process in children under three years old. Young children are very flexible and will appear to have a foot that is rolled in and pointing outward. However, after the age of three, you should see a podiatrist if your child’s foot still appears flat, particularly as they near kindergarten age.
The podiatrist will evaluate the entire lower extremity from hip to toe to determine if the child is experiencing any weakness or pain and to pinpoint the exact level where the deformity begins. Symptoms of flat foot can include pain in the foot, ankle or knee. The child may have a history of clumsiness, ask to be carried often or avoid physical activity. The doctor will take x-rays to evaluate the joints and alignment of the bones. A tight calf is a common finding in all flatfoot patients, which can be a significant component to the patient’s present and future pain since it causes the foot to compensate and function out of alignment. Therefore, it is common for children to undergo physical therapy to learn stretches and exercises that target the calf muscles to allow for more normal biomechanics or foot function. The gold standard for treating pediatric flat foot is orthotic therapy. Orthotics are custom made shoe inserts that restore proper biomechanics by correctly aligning the joints, ligaments and tendons of the foot. Since orthotics are custom made, they are designed to address each child’s specific foot structure and associated problems. Although they do not restore proper position of the foot, these devices maintain the correct position of the foot to help prevent the flat foot from progressing and decrease the current pain that the child is experiencing while in use.
In rare cases, a child will continue to experience pain or disabling fatigue after all conservative treatments have been attempted. In these cases, surgery becomes the treatment of last resort. One of the most common procedures for pediatric flat foot is known as the subtalar arthroeresis or “implantable orthotic”, an implant that is placed in the rear part of the foot. The procedure takes only seven minutes and is done through a tiny incision. The implant creates an immediate arch allowing the patient to bear weight immediately and rarely needs to be removed. This procedure is done in children with severe pain in the arch or where the arch is so collapsed that it will lead to an arthritic condition when they get older.
Many parents worry about their children’s flat feet, but in most cases children grow out of it by the time they reach kindergarten. However, if you suspect your child has a severe case or does not appear to be outgrowing their flat foot, it is always best to see a podiatrist as soon as possible, preferably before age three, to evaluate and treat them if necessary. After age three flat foot treatment becomes less effective and more complicated.